Prevention and control of non-communicable diseases ( Report of the Secretary-General – UN )

Summary
Non-communicable diseases represent a new frontier in the fight to improve global health. Worldwide, the increase in such diseases means that they are now responsible for more deaths than all other causes combined. Commonly known as chronic or lifestyle-related diseases, the main non-communicable diseases are cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. While the international community has focused on communicable diseases such as HIV/AIDS, malaria and tuberculosis, the four main non-communicable diseases have emerged relatively unnoticed in the developing world and are now becoming a global epidemic. However, such diseases could be significantly reduced and prevented, with millions of lives saved and untold suffering avoided, through proven and affordable measures, many of which are complementary to global health efforts already under way. The knowledge and
technology to fight the onset and effects of non-communicable diseases already exist.
It’s time to act to save future generations from the health and socio-economic harm of such diseases.
Note: The primary focus of the present report is on the four groups of diseases covered by the Global Strategy for the Prevention and Control of Non-communicable Diseases: cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, which are largely caused by four shared behavioural risk factors. The same focus is given by General Assembly resolution 64/265. The broader scope of non-communicable diseases also includes conditions such as gastrointestinal diseases, renal diseases, neurological and mental health disorders. Those conditions account for a substantial portion of the global burden of disease. Although they are not specifically addressed by the content and focus of the present report, many of the approaches and opportunities for tackling non-communicable diseases described are also directly relevant to those conditions.
In 2008, 36 million people died from non-communicable diseases, representing 63 per cent of the 57 million global deaths that year. In 2030, such diseases are projected to claim the lives of 52 million people. However, the demographic of lives lost is not readily apparent; people with non-communicable diseases often die young, with 9 million annual deaths occurring in persons under 60 years of age. The
epidemic is fuelled by a combination of rising risk factors, including tobacco use, an unhealthy diet, lack of physical activity and harmful alcohol use. The four main non-communicable diseases that share those risk factors cause almost 80 per cent of all deaths from such diseases. Non-communicable diseases affect the developing world and lower-income populations hardest. Strong evidence links poverty, lack of education and other social determinants to such diseases and their risk factors. A vicious cycle is created by the epidemic, whereby non-communicable diseases and their risk factors worsen poverty,
while poverty results in rising rates of such diseases. The prevention of
non-communicable diseases would reduce poverty, particularly since the majority of expenditures for treatment in low- and middle-income countries are paid privately or from out-of-pocket health-care systems. At the same time, because of the magnitude of the illness, the disabilities and premature deaths they cause and the long-term care
required, non-communicable diseases reduce productivity and increase health-care costs, thereby weakening national economic development.
While non-communicable diseases have traditionally afflicted mostly high income populations, current evidence shows that the spread of such diseases is associated with increasing levels of development. Death and disease from non-communicable diseases now outstrip communicable diseases in every region except Africa, where the rate of such diseases is quickly rising. By 2030,non-communicable diseases are projected to cause nearly five times as many deathsas communicable diseases worldwide, including in low- and middle-income countries.
The burden of non-communicable diseases in low- and middle-income
countries goes beyond the fact that those countries are home to the world’s largest populations. Unplanned urbanization, ageing populations and the globalization of trade and product marketing, particularly for tobacco, alcohol and food, have led to a rise in the risk factors of such diseases. The lack of health-care capacity and social
protection systems in lower-income countries means that non-communicable diseases are more likely to cause people to become sick and die from them at earlier ages.
Furthermore, the health and socio-economic toll of the non-communicable disease epidemic is impeding achievement of the Millennium Development Goals,
which are falling short of targets set in many countries. That is especially the case for Goals 4 and 5, on women’s and children’s health, which are intricately linked to non-communicable diseases, specifically since poor nutrition during pregnancy and early life causes a predisposition to high blood pressure, heart disease and diabetes
later in life.
However, the impact of non-communicable diseases can be prevented with an approach that incorporates cost-effective, population-wide health-care interventions
to address risk factors, known as public health “best buys”, and primary health-care measures to treat those who have contracted or are at high risk of contracting such diseases. The widespread implementation of such interventions, which require modest investment, can lead to quick gains in counteracting the effects of
non-communicable diseases.
The best buys for population-wide interventions include tobacco-control measures, including raising taxes and bans on advertising and smoking in public places; raising taxes on alcohol and enforcing bans on alcohol advertising; reducing salt intake; replacing trans-fats in foods with polyunsaturated fats; promoting public awareness about diet and physical activity; and delivering hepatitis B vaccinations.
Primary health-care interventions include counselling, multi-drug therapy and early treatment for cervical and breast cancers.
The obstacles are many yet the moral, social and economic imperative is clear. At present, there is an unprecedented ability to critically analyse weaknesses and opportunities in the emerging battle to prevent and control non-communicable diseases. Throughout the debate over best policy and programme action, it must be remembered that the health and socio-economic impacts of such diseases are largely
preventable and that the public health foundation of research and technical skill needed for progress is strong.
Five recommendations for progress are as follows:
(a) The greatest reductions in non-communicable diseases will come from a complete Government approach to adopting population-wide interventions that address risk factors. Those interventions can be achieved through modest and costeffective
investment;
(b) Sustained primary health-care measures, including prioritized packages of essential interventions, along with palliative and long-term care, must be implemented for those who already have non-communicable diseases or who are at high risk of contracting them. Many of the health-care interventions can, at low cost,
be supported through health-related public policies;
(c) Addressing non-communicable diseases requires strengthening the
capacity of Member States to monitor such diseases, their risk factors and determinants, especially in lower-income countries and including social data disaggregated by, for example, gender;
(d) Lessons learned from national HIV/AIDS, tuberculosis and malaria
programmes in low- and middle-income countries must be harnessed for effectiveintegration of communicable and non-communicable disease initiatives;
(e) Prevention and control of non-communicable diseases must be givenpriority, and commitments must be made at the highest levels by Governments, theprivate sector, civil society, the United Nations and international organizations, which should all work together.

Recommendations
It is recommended that Member States:
(a) Include prevention and control of non-communicable diseases among priorities in national health strategies and plans;
(b) Implement cost-effective population-wide interventions, including
through regulatory and legislative actions, for the non-communicable diseaserelated risk factors of tobacco use, unhealthy diet, lack of physical activity and harmful alcohol use;
(c) Strengthen national information systems by implementing a surveillance framework that monitors key risk factors and determinants, morbidity and mortality and health-system capacity. Set standardized national targets and indicators to assess the progress made in addressing non-communicable diseases;
(d) Promote multisectoral and “health in all policies” approaches to address the social determinants and risk factors of non-communicable diseases;
(e) Engage non-health sectors and key stakeholders, including the private sector and civil society, in collaborative partnerships to promote health and reduce non-communicable disease-related risk factors;
(f) Implement international agreements and strategies to reduce risk factors, including the 2003 WHO Framework Convention on Tobacco Control, the Global Strategy on Diet, Physical Activity and Health and the Global Strategy to Reduce the Harmful Use of Alcohol;
(g) Revitalize primary health care and promote access to cost-effective
interventions for non-communicable diseases, including access to essential medicines and technologies;
(h) Mobilize additional resources and support innovative approaches to
financing essential non-communicable disease health-care interventions within primary health care.

It is recommended that the private sector:
(a) Promote healthy behaviour among workers, including occupational safety through good corporate practices, workplace wellness programmes and insurance plans;
(b) Contribute to improved access and affordability for the essential
medicines and technologies for non-communicable diseases;
(c) Ensure responsible and accountable marketing and advertising, especially with regard to children;
(d) Ensure that foods needed for a healthy diet are accessible, including
reformulating products to provide healthier options.

It is recommended that civil society:
(a) Mobilize political and community awareness in support of
non-communicable disease prevention and control;
(b) Address shortcomings in non-communicable disease prevention and treatment services for marginalized populations and crisis situations and build community capacity in promoting healthy diets and lifestyles;
(c) Mobilize additional resources and support innovative approaches to
financing the prevention and control of non-communicable disease.

It is recommended that United Nations agencies and internationalorganizations:
(a) Acknowledge the threat of the non-communicable disease epidemics to sustainable development and integrate cost-effective preventive interventions into the development agenda and related investment programmes, including poverty reduction initiatives, in low- and middle-income countries;
(b) Develop, in collaboration with Member States, a global set of indicators to monitor non-communicable disease trends and assess the progress countries are making to reduce the burden of such diseases;
(c) Ensure the effective engagement of all non-health sectors in health and non-communicable disease policies;
(d) Ensure the active engagement of United Nations agencies, funds and programmes in global and regional initiatives to address the health and socio-economic impacts of non-communicable diseases.